Record Of Order For Child Support
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1RECORD OF ORDER FOR CHILD SUPPORT
To be completed only if child support is to be paid through the Texas Child Support Disbursement Unit (TXSDU).
Please Type All Information – Please complete appropriate spaces
Please call the Director of Child Support Registry at (956) 544-0840 if you have any questions concerning completion of this form.
This document must be submitted with the Decree of Divorce.
Cause No. _____________________________
DOMESTIC VIOLENCE INDICATOR?
YES
NO
SECTION 1 GENERAL INFORMATION (REQUIRED)
FIRST NAME
MIDDLE
LAST
SUFFIX
DATE OF BIRTH (mm/dd/yyyy)
MALE
FEMALE
ADDRESS
CITY
COUNTY
STATE
ZIP
SOCIAL SECURITY NUMBER
TELEPHONE NUMBER
DRIVER’S LICENSE NUMBER
STATE OF ISSUANCE
FIRST NAME
MIDDLE
LAST
SUFFIX
DATE OF BIRTH (mm/dd/yyyy)
MALE
FEMALE
ADDRESS
CITY
COUNTY
STATE
ZIP
SOCIAL SECURITY NUMBER
TELEPHONE NUMBER
DRIVER’S LICENSE NUMBER
STATE OF ISSUANCE
SECTION 2 CHILDREN AFFECTED BY THIS SUIT
FIRST NAME
MIDDLE
LAST
SUFFIX
DATE OF BIRTH (mm/dd/yyyy)
MALE
FEMALE
SOCIAL SECURITY NUMBER
ADDRESS
CITY
COUNTY
STATE
ZIP
FIRST NAME
MIDDLE
LAST
SUFFIX
DATE OF BIRTH (mm/dd/yyyy)
MALE
FEMALE
SOCIAL SECURITY NUMBER
ADDRESS
CITY
COUNTY
STATE
ZIP
FIRST NAME
MIDDLE
LAST
SUFFIX
DATE OF BIRTH (mm/dd/yyyy)
MALE
FEMALE
SOCIAL SECURITY NUMBER
ADDRESS
CITY
COUNTY
STATE
ZIP
FIRST NAME
MIDDLE
LAST
SUFFIX
DATE OF BIRTH (mm/dd/yyyy)
MALE
FEMALE
SOCIAL SECURITY NUMBER
ADDRESS
CITY
COUNTY
STATE
ZIP
ORDER OF PAYMENT
The information provided below must include the amount of the child support and/or arrears ordered, the frequency of payment, and a start date. Only child support payments
may be paid through the CHILD SUPPORT REGISTRY.
SECTION 3 - REGULAR CHILD SUPPORT PAYMENTS (Total Amount for
child(ren))
CHILD SUPPORT PAYMENTS
ARREARS
Will a wage assignment or allotment be initiated?
Beginning on:
Beginning on:
Weekly
Weekly
Yes
No
Alternating Weeks _________________
Alternating Weeks _________________
(if yes, please submit a Request for Issuance of
Amount:
Amount:
Monthly
Monthly
Wage Withholding Order to the District Clerk’s
Office with the fee of $30.00.)
Semi-Monthly
_________________
Semi-Monthly
_________________
$
$
NAME OF INDIVIDUAL COMPLETING FORM
PHONE NUMBER
DATE
Signed this the ___________ day of ________________________________, _______________.
__________________________________________________
PRESIDING JUDGE
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